Managing neuropathic pain after surgery

Abstract

Once persistent neuropathic pain after surgery is established, treatment can be difficult but should be individualised, multimodal and, if necessary, multidisciplinary. The ultimate goal is to restore function and quality of life rather than exclusively target pain scores.

Key Points - Surgery is an increasingly common cause of persistent neuropathic pain. About 20 to 50% of patients experience persistent pain after surgery, with severe pain occurring in 2 to 10%. - Prevention by avoidance of unnecessary surgery is a key strategy while more research into risk stratification and pharmacological preventive strategies is being pursued. - The treatment of neuropathic persistent postsurgical pain (PPSP) should be individualised, multimodal and, where necessary, multidisciplinary. Patients with PPSP that is severe and/or causes high levels of disability or distress should be referred to a pain management unit. - PPSP that is neuropathic should be treated according to current guidelines; however, there is limited evidence to help guide prescribers. Opioid medications should be used with caution after the immediate perioperative period.